抗生素使用与下呼吸道感染菌群变化及耐药性分析  

作　　者：吉冬元[1] 孟庆华[1] 叶胜兰[1] 李承红[1] 

机构地区：[1]湖北省武汉市第六医院呼吸内科,430015

出　　处：《中华临床医学杂志》2007年第9期5-7,共3页Chinese Journal of Clinical Practical Medicine

摘　　要：目的了解下呼吸道感染菌群和耐药性变化新特点与抗生素使用之相关性以指导临床合理用药。方法选取我院2000年1月～2004年12月确诊为下呼吸道感染的住院患者302例，其中男性184例，女性118例，平均年龄62．7岁。对每一位下呼吸道感染病例抗生素使用情况进行分类统计并按百分比多少排序。采集每例下呼吸道感染病人晨痰经涂片筛检为合格标本后再培养分离并鉴定到种，共检出337株致病菌（真菌除外）。采用Kirby-bauer扩散法进行药敏分析，试验结果判定采用1999年美国国家临床实验室委员会（NCCLS）标准执行。结果抗生素使用情况是第三代头孢菌素占第一位（41．39％），其余依次为喹诺酮类（29．80％），一、二代头孢菌素（20．20％）等；分离培养出的337株病原菌排名前五位的依次为铜绿假单胞菌133株，对头孢唑啉耐药最高（100％），对阿米卡星耐药率最低（26．90％）；肺炎克雷伯菌50株，对头孢唑啉耐药率最高（56.30％），对头孢哌酮＋舒巴坦耐药率最低（11．32％）；大肠埃希氏菌36株，对头孢唑啉耐药率最高（40．30％），对阿米卡星最低（7．35％）；阴沟肠杆菌12株，对头孢哌酮耐药率最高（41．32％），对氧氟沙星最低（22、24％）；金黄色葡萄球菌10株，对青霉素和头孢噻肟最高（100％），对头孢唑啉最低（26．70％）。结论三代头孢菌素使用最多、喹诺酮类使用大有超过头孢菌素之势，由此革兰氏阴性菌检出率明显上升且种类增加，耐药性也随着三代头孢菌素和喹诺酮类大量使用而逐渐增高。Objective Comprehending the correlation of the flora of lower respiratory tract infection, which new changes of tolerance and antibiotic usage to instruct clinical medication reasonably. Methods Selecting 302 hospitalization patients who were final diagnosis for Lower respiratory tract infection from all of the patients since 2000 January to 2004 December. There were 184 males and 118 females. The average age was 62.7 years. We statistical classified the fact of how to use antibiotics of every one who had Lower respiratory tract infection and sorted it according to percentage. We raised, separated and appraised the specimen which were collected from every patient＇ s morning phlegm who had Lower respiratory tract infection and thought as qualified by smear and screening. At last, we got 337 strains of pathogenic bacterias （except from fungi）. We undertook the analysis of medicine sensitivity in Kirby-bauer irradiation method and judged the test effect by the standard of 1999＇ s National Clinical Laboratory Committee（NCCLS）. Results The Third generation cephalosporin＇ s using frequency was the first, the second was Quinolones, the third was First generation cephalosporin and Second generation cephalosporin, and etc. The top five ranking of the 337 strains of pathogenic bacterias was the Pseudomonas aeruginosa 133 strains, the drug resistance rate of cefacidal was highest （100%）, the rate of Amikacin was lowest （26.9%）, the Klebsiella pneumoniae 50 strains, the drug resistance rate of cefacidal was highest （56.3%）, the rate of cefoperazone ＋ sulbactam was lowest （11.32%）, the Enteropathogenic escherichia coli 36 strains, the drug resistance rate of cefacidal was highest （40.3%）, the rate of Amikacin was lowest （7.35%）, the Enterobacter cloasas 12 strains, the drug resistance rate of cefoperazone was highest （41.32%）, the rate of ofloxacin was lowest （22.24%）, the staphylococcus aureus 10 strains, the drug resistance of penicillin and cefotaxime was highest （100%）,

关 键 词：抗生素 下呼吸道 细菌 耐药性 

分 类 号：R969.3[医药卫生—药理学]